Quantitative analysis of corneal nerve fibers in type 2 diabetics with and without diabetic peripheral neuropathy: Comparison of manual and automated assessments

•Manual and full-automated methods for the whole cohort were significantly positive correlated for CNFL, CNBD and CNFD.•Bland–Altman plots showed good agreement between the manual and fully automated analyses of CNFL and CNBD.•Both manual and automated measurements can effectively distinguish between subjects with and without DPN.•Fully-automated corneal nerve quantification may be a fast, objective way to detect DPN. To examine and compare fully-automated and manually measured corneal nerve fiber parameters in type 2 diabetes mellitus (T2DM) patients with and without diabetic peripheral neuropathy (DPN). A total of 128 T2DM subjects and 24 healthy controls underwent neuropathy assessment and bilateral corneal confocal microscopy (CCM). Five representative nerve fiber images were selected for each participant and analyzed manually and with fully-automated software. Corneal nerve fiber length (CNFL), branch density (CNBD), and fiber density (CNFD) were examined. Manual and full-automated methods for the whole cohort were significantly positive correlated for CNFL, CNBD and CNFD (r = 0.818, 0.845, 0.457, all P